I am confused by the ongoing dispute about whether we should legalize assisted suicide in Montana. I am a medical doctor whose patients include incarcerated persons. Law enforcement, jails and prisons are mandated to monitor for signs of depression and suicidal ideation, and to identify, intervene and/or initiate treatment. We are told that our failure to do so would be a significant breach of an inmate’s civil rights. Yet according to proponents of assisted suicide, patients also have a right to receive a doctor’s assistance with the suicide. This makes no sense.

On the one hand, you have a group of people (prisoners) who suffer from situational depression due to their circumstances. Suicide attempts in this population are not rare. On the other hand, you have a group of people (persons diagnosed with a terminal diagnosis) who suffer from situational depression due to their circumstances. Why is one group entitled to protection and the other is not? Is it because with the second group, you call it “aid in dying” because people are dying anyway? They may not be dying anyway. Doctors diagnoses can be wrong. I have seen patients in my own practice live longer than expected. What about an older inmate? Would he be entitled to protection or a lethal dose? This all strikes me as very Orwellian and also discriminatory to people labelled terminal. I thought freedom from discrimination was a constitutional right.

I have seen suicidal people get better and rebuild lives that looked pretty grim. I do not agree that doctors or anyone else should be steering people to suicide in Montana. I hope that our legislature will clarify once and for all that assisted suicide is not legal in Montana.

The letter I wrote to the Revalli Republic newspaper in Montana on assisted suicide and elder abuse was published online today. I was told by the newspaper that they only publish letters from people in Montana in the newspaper but they publish all applicable letter online. Nonetheless, I thought it was worth writing and I think it is worth reading.

This letter responds to your recent AP article about assisted-suicide (Associated Press, Nov. 16). I write to emphasize elder financial abuse as a reason to keep assisted suicide out of Montana.

The landmark 2009 report by MetLife Mature Market Institute describes elder financial abuse as a crime “growing in intensity.” (See: www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf, p.16.) The perpetrators are often family members, some of whom feel themselves “entitled” to the elder’s assets (Id, pp. 13-14.) The report states that they start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or coercing elders to sign over the deeds to their homes, change their wills or liquidate their assets (Id, p. 14.) The report states that victims “may even be murdered” by perpetrators (Id., p. 24.)

With legal assisted suicide in Oregon and Washington state, perpetrators are instead able to take a “legal” route by getting an elder to sign a lethal dose request. Once the prescription is filled, there is no supervision over administration. The elder could be cajoled or coerced into taking the lethal dose, for example, while under the influence of alcohol. The lethal dose could be administered while the elder slept. If he awoke and struggled, who would know?

Thank you for publishing the letter by Dr. Ken Stevens describing how he talked his patient out of doing assisted suicide in Oregon. I am that patient and he did save my life.In 1997, I voted for the initiative that legalized assisted suicide in Oregon.In 2000, I was diagnosed with cancer and told that I had six months to a year to live. I knew that our law had passed, but I didn’t know exactly how to go about doing it. I did not want to suffer, and I did not want to do radiation. I wanted Stevens to help me, but he didn’t really answer me.Instead, he encouraged me to not give up and ultimately I decided to fight the cancer. I had both chemotherapy and radiation. I am so happy to be alive!It is now 12 years later. If Stevens had believed in assisted suicide, I would be dead. I thank him and all my doctors for helping me choose “life with dignity.”Assisted suicide should not be legal.Thank you so much.Jeanette Hall,King City, Oregon

Vermont Governor, Peter Shumlin, has stated, once again, that Vermont will legalize assisted suicide in the 2013 legislative session.Shumlin, who is a long-time supporter of assisted suicide and received money from the assisted suicide lobby during his 2010 leadership campaign, stated in 2011 and 2012 that the Vermont legislature would legalize assisted suicide and both attempts failed.The Barre Montpelier Times Argus reported in an article published today by Peter Hirshfeld that:

From “death with dignity” to marijuana decriminalization, Gov. Peter Shumlin on Tuesday said he aims to seal the deal on several notable pieces of unfinished business from the last legislative biennium.

Governor Peter Shumlin

“I’m confident that regardless of who leads the various bodies in the Legislature, that we can pass decriminalization of marijuana, death with dignity and the (unionization) bill for child care workers,” he said. “We’re going to get them done.”

Key lawmakers aren’t so sure.

Sen. John Campbell, the Windsor County Democrat nominated to a second term as Senate president by his party colleagues Tuesday afternoon, was the Statehouse’s most prominent opponent of the child care unionization bill and legislation that would let terminally ill patients get a prescription that would end their lives. He said Tuesday his positions on those issues have not evolved in recent months, and that he’s not convinced either has the support needed to make it through the Legislature.

Campbell, however, said he won’t try to squelch a vote on any end-of-life legislation. In fact, he said the topic in 2013 will receive more attention from Senate committees than it did in either of the last two sessions.

“I recognize that this issue is not going to go away, and if the majority of people want to have a debate, then that debate should happen,” he said.

Campbell said he envisions joint hearings of Senate committees on the judiciary and health and welfare. He said the hearings come in response to requests for additional debate from people on both sides of the issue.

“If it passes, it passes. If it doesn’t, it doesn’t,” Campbell said. “But I think everyone involved in this conversation agrees there are issues that need to be vetted, so I think it’s worth taking the time to vet them.”

At the same time Vermont Public Radio reported that Shumlin is seeking to eliminate the deficit in 2013 through budget cuts and not tax increases. The report stated:

The Shumlin Administration is in the process of drafting its budget for next year and the Governor says he's asking all agencies and departments of state government to submit a level funded spending plan for policy makers to consider.

Shumlin says the state once again faces a sizeable gap between available revenue and budget demands and he says the solution is not to increase any broad based taxes.

"We've got some tough fiscal times that need to be dealt with once again," said Shumlin. "I was hoping that we wouldn't be back here dealing with another $50 million to $70 million budget deficit, we are, and I'm going to be presenting a budget that's going to ask the Legislature to once again balance the budget the old fashioned way by making tough spending choices not raising broad based taxes."

The following alert was received from Paul Russell, the leader of HOPE Australia, concerning the new push to legalize euthanasia in Australia. You will notice that the euthanasia lobby in Australia is claiming that overturning the Federal Euthanasia Laws are actually an issue of "territory rights". Therefore they are suggesting that this bill not be a free vote. They realize that it would be hard to pass this bill in the Australian Senate if it is a free vote. The update from Paul Russell:

Paul Russell - HOPE Australia, November 28, 2012

On Monday the 26th of November Senator Di Natale introduced a new bill to overturn the Federal Euthanasia Laws Act 1997 which prohibited all three Australian Territories with limited self-government from passing laws on euthanasia & assisted suicide.

Only days earlier, retired Senator Bob Brown’s Bill with the same ends was finally withdrawn from the Senate Notice Paper. Interestingly, Di Natale’s bill was identical to that moved by Senator Brown in 2010.

Australia's Federal Parliament

Former Chief Minister of the NT, Marshall Perron and architect of the Rights of the Terminally Ill Act (ROTI) (which was in force in the Northern territory for a brief period before the Federal Bill took precedence) has argued that this new Di Natale Bill should not be subject to a conscience vote because it was principally about Territory Rights and not about euthanasia.

Not so. The debate in 1996/97 on the Euthanasia Laws Act was essentially about whether or not the ROTI act was in keeping with good government and whether or not the Federal responsibility for the good government of the territories included not allowing euthanasia & assisted suicide legislation to stand. It was a debate about euthanasia in the context of the territories and their constitutional relationship to the Federal Parliament.

If we needed any more proof that this is about euthanasia, we would only need look to recent comments from politicians in both the ACT and the NT. ACT MLC, Shane Rattenbury confirmed to ABC News that he supported the Di Natale move and would look to drafting legislation at some future moment. Likewise, the Speaker of the NT Legislative Assembly, Kezia Purick also told the ABC that she would look to introduce a private member’s bill. The NT News said that the NT Labor Leader, Delia Lawrie, supports the idea of euthanasia.

Lawrie also added that she doubted that the Di Natale push would be successful.

For more information on the Di Natale bill CLICK HERE to go to the Federal page on the HOPE website.

If you’re from South Australia, there’s a bill that also needs your attention. CLICK HERE.

Monday, November 26, 2012

In the past year there have been three reports and two court cases concerning the legalization of euthanasia and/or assisted suicide in Canada and the UK. All three reports concluded that euthanasia and/or assisted suicide can be safely legalized and one of the court cases came to the same conclusion.

It has recently been reported that another study on the legalization is being prepared in Australia.

Reports that are written from a one-sided perspective, that intentionally ignore data from Belgium and the Netherlands that prove that legalizing euthanasia will result in vulnerable patient groups losing their lives by euthanasia without request, are not needed because they already exist.

In response to these one-sided reports and the decision by Justice Lynn Smith in the Carter case in BC, I decided to research and compare the most recent peer reviewed studies concerning the practice of euthanasia and assisted suicide in Belgium and the Netherlands.

By analysing the data from three studies on the practice of euthanasia in Belgium (Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey - CMAJ June 15, 2010,The role of nurses in physician-assisted deaths in Belgium - CMAJ June 15, 2010, Reporting of euthanasia in medical practice in Flanders Belgium: cross sectional analysis of reported and unreported cases - BMJ November, 2010) and the most recent major study on the practice of euthanasia and assisted suicide in the Netherlands (Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey - Lancet July 2012) we learn that the practice of euthanasia is often abused and the euthanasia law is often ignored.

A further analysis of these four peer reviewed studies indicates that:
1.When a physician reports a euthanasia death, as euthanasia, the physician usually follows the rules that are outlined by the law.

2.When a physician does not report a euthanasia death, as euthanasia, the physician usually does not follow the rules that are outlined by the law.

3.The reasons for not reporting a euthanasia death, as euthanasia, include the following: to avoid the administrative burden, the legal due requirements were not met or to avoid possible legal consequences. Often the physician never intended to report the death as euthanasia.

4.When a euthanasia death is not reported in Belgium, or done without explicit request the patient is more likely to be over the age of 80, die in a hospital, and is often incompetent to consent to the act. The same demographic is also over represented when a euthanasia death is done by a nurse in Belgium. Euthanasia deaths that are done without explicit request, that are unreported, or that are done by nurses fit the same demographic group. This demographic group "fits the description of a 'vulnerable' patient group" who have died by euthanasia without request.

5.Euthanasia deaths that are done by nurses in Belgium are not legal but occur. These deaths are usually done by order of a physician, but sometimes they are done without consulting a physician. These deaths are usually done by intentional opioid overdose, even though sometimes they are done by neuromuscular relaxants. Nurses who had previously been involved with a euthanasia death and male nurses were far more likely to carry-out euthanasia in Belgium.

One-sided reports on euthanasia and assisted suicide.

In November 2011, the Royal Society of Canada published its one-sided End-of-Life Decision Making panel report stating that euthanasia and assisted suicide can be safely legalized and based on evidence from jurisdictions where "assisted death" has been legalized, there is no fear of a "slippery slope." From its inception, the End-of-Life Decision Making panel was stacked with pro-euthanasia activists.

In January 2012, the Commission on Assisted Dying in the UK published its one-sided report calling for the legalization of assisted suicide in the UK. Also known as the Falconer Commission report, it was funded by euthanasia activist Terry Pratchett and the assisted suicide lobby in the UK and chaired by Lord Falconer, a long-time promoter of legalizing assisted suicide.

In March 2012, the Quebec government Dying with Dignity report recommended the legalization of euthanasia in Quebec. The report stated that Quebec could safely legalize euthanasia as a medical act in a similar manner to the Belgium euthanasia law. From the outset, members of the committee advocated for Belgium style euthanasia.

In June 2012, Justice Lynn Smith decided in the Carter case in British Columbia to strike down Canada's assisted suicide law and to order parliament to legalize euthanasia. Smith stated that "assisted death" could be safely legalized in Canada and that there are no signs of a "slippery slope" in jurisdictions where it is legal.

In August 2012, a three judge High Court panel in the UK found in the Nicklinson/Martin case that the court had no authority to overturn the UK laws preventing euthanasia and assisted suicide. The UK High Court found that only parliament could change the law.

The reports that were published by the Royal Society of Canada, the Commission on Dying in the UK and the Quebec Dying with Dignity report are one-sided reports that appear to have ignored the data from Belgium and the Netherlands that prove that vulnerable patient groups are dying by euthanasia without request and that doctors are abusing the law and covering it up by not reporting the death as euthanasia.

The decision by Justice Smith in the Carter case was heavily based on the Royal Society of Canada report and needs to be overturned for its lack of objectivity.

The world of organ donation in Denmark is in turmoil. A documentary
was aired earlier this month which showed family members reacting in
anguish to the news that their 19-year-old daughter was brain dead after
a car accident, agreeing to donate her organs and allowing doctors to
turn off her respirator. About 1.7 million viewers tuned in to the
heart-rending drama.

Carina Melchior

But Carina Melchior did not die after her respirator was removed. She
is now undergoing rehabilitation and may make a full recovery. About
500 people immediately removed their names from Denmark’s organ donor
register.

Doctors at Aarhus University Hospital were embarrassed by the
incident. “We are overjoyed that the young woman survived and that she
is moving on after the accident,” Claus Thomsen, the hospital’s chief
medical officer, said. “But we made a mistake underway and made the
family believe that their daughter and sister would die.”

The hospital acknowledged that the question of organ donation should
not have been raised as there were no unambiguous signs that brain death
would occur. New guidelines have been introduced to ensure that
relatives will only be approached about organ donation if no more
treatment options are available. There was no risk of a false diagnosis
of brain death, the hospital insisted.

But in more bad publicity for the hospital, a Danish tabloid profiled
a man who had been falsely diagnosed as brain dead in 2002. He
recovered quickly.

Aarhus University Hospital is investigating both cases, although it
insists that the correct procedures were followed in the earlier case.

Carina’s family is now suing the hospital for damages. Her family’s
lawyer claims that she keeps asking whether her doctors were trying to
kill her. “Those bandits in white coats gave up too quickly because they
wanted an organ donor,” Carina’s father told the Danish newspaper
Ekstra Bladet.

Last year, Philip Nitschke, Australia's Dr. Death, established a fake brewing company to enable him to distribute tanks of Nitrogen gas without the authorities noticing what he was doing. Paul Russell, the leader of HOPE Australia, sent the information from NItschke's website to the medical authorities to question whether Nitschke was breaking the code of ethics for physicians by counselling and providing the means for suicide.Nitschke is upset because the legal coverage that is provided for doctors in Australia will not cover the legal proceedings related to this case because it has nothing to do with his medical practice.The Age newspaper in Australia, published an article written by Julia Medew on November 26 outlining the concerns of the case. The article states:

Euthanasia campaigner Dr Philip Nitschke says he has been abandoned by his medical indemnity insurer as he fights a new medical board investigation that threatens his registration.

Anti euthanasia group, Hope, has complained about Dr Nitschke’s promotion and sale of nitrogen to members of Exit International, saying it has "overstepped the bounds of reasonable behaviour" and makes him an unfit person to hold a medical license.

Last year, Dr Nitschke set up a company to sell nitrogen to members of his group who are interested in buying the gas to commit suicide. The company’s website does not mention Exit International or Dr Nitschke.

In a complaint to the Australian Health Practitioner Regulation Authority, executive director of Hope, Paul Russell, said although Dr Nitschke’s group had advised people of various methods to commit suicide in the past, selling nitrogen to people created "a far more direct relationship between Exit/Nitschke and the suicide candidate".

While Dr Nitschke says he works predominantly as a human rights activist and scientist when he works for Exit International, Mr Russell has called for AHPRA to consider his workshops medical consultations.

"Were he to provide the kind of information he promotes in his workshops to a patient in his consulting rooms I doubt that anyone would disagree that such behaviour is inappropriate," Mr Russell said in his complaint.

In a letter to Dr Nitschke, AHPRA said it was investigating the matter. Under the Health Practitioner Regulation National Law, it has the power to act against a practitioner who is not considered "a fit and proper person" to practice. It can suspend or cancel a doctor’s registration.

My question is: If Philip Nitschke thought that there was nothing illegal or unethical about distributing Nitrogen tanks to people for the purpose of suicide, then why did he establish a fake brewing company for that purpose?

Sunday, November 25, 2012

The following article was written by Dr. Sinéad Donnelly, a consultant in palliative care from Wellington New Zealand. The article was published in the Journal of the New Zealand Medical Association, November 23, 2012, Vol 125 No 1366.

Sinéad Donnelly

I come from a long line of doctors; since 1905, three generations and seven doctors. From my general practitioner grandfather I have learned the art of attending in medicine. From my physician father I have learned the art of observing. I am a palliative medicine physician for 21 years. I practise the art and science of palliative medicine.

As a palliative medicine physician I care for 400 each year for 21 years who have advanced disease and who have died. I have worked and trained in Ireland, Scotland and United States and have been in New Zealand for the past 4 years.

My whole being cries out “do not do this” to the concept of legalising euthanasia in this country.

The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of physical symptoms. Of particular note, it says that palliative care affirms life, regards dying as a normal process and intends neither to hasten nor postpone death.

I am opposed to euthanasia as a doctor and as a palliative medicine physician. ANZSPM Aotearoa (New Zealand branch) of which I am chair represents 86 doctors in New Zealand who practice palliative medicine. We agree with the New Zealand Medical Association (representing over 5000 doctors) in stating that euthanasia—i.e. a doctor deliberately ending the life of a patient—is unethical and illegal.

The annual meeting of ANZSPM Aotearoa in Queenstown this year included a discussion on Maryan Street’s (Labour Party Spokesperson on Health) proposed Bill. There was unanimous opposition to the legalisation of euthanasia.

Every day I spend hours with people who are facing death, whose greatest need in my experience is to be truly heard, truly listened to, not abandoned emotionally or physically. People yearn so much to receive care unconditionally. They are sensitive acutely to any sign that others feel they are a burden. When they sense this by a look, a tone, a pause, a lack of a pause, the pace of a conversation, they close down, retreat and their overall suffering increases.

For me the essence of medicine and the therapeutic relationship is listening with particular attention. I have laboured to achieve that over many years as a doctor, honing my skills in several countries, adding to my experience to serve others. Listening is a form of touch; it is an analogous to auscultation of the heart knowing specifically what abnormal heart sounds or murmurs to listen for. Listening in medicine is not to be perceived as an act of benevolence born out of compassion but instead approached as essential clinical skill that is as much science as art.

International literature identifies that the main reason for people supporting euthanasia is not due to intolerable pain but is instead people feeling a burden and loneliness. Euthanasia is not the answer to society’s disease of loneliness. The strongest predictive factor from the international literature for a wish to hasten death in those with terminal illnesses is hopelessness.

Euthanasia

Euthanasia is not an answer to society’s disease of hopelessness. The word euthanasia disguises a practice which one might abhor if it were given another name and the other name would be “to kill” someone. Let us take the protective cloak of medicine away in what is this in fact deliberately ending the life of another person. Being treated with dignity is not only about self control, autonomy, independence, maintaining physical function. It is also present when one is honoured and treated with esteem. Caring lovingly for someone is itself an act of dignity and can provide dignity to another.

My experience has taught me how complex is each person, how individual is their life and death, how again and again people respond to holistic care and attention. The law is there to protect the vulnerable. Maryan Street’s Bill will in fact expose the vulnerable. This is a matter of public safety. Professor of Palliative Medicine Ilora Finlay has stated “the Bill you have before you in New Zealand is the most radical and extreme of any piece of legislation anywhere in the world because basically it is euthanasia on demand. It safe guards our people to the point of being absent.”

This Bill will include anyone who suffers from an irreversible, physical or mental condition that in the person’s view renders his or her life unbearable. This will include a person with diabetes, arthritis, anorexia nervosa, depression. Any person with a chronic illness will be included within the legislation. This runs counters to our efforts to reduce the incidence of suicide not to promote suicide.

Clause 27 of Maryan Street’s Bill requires a medical practitioner who declined to participate to provide alternative source of medical assistance. There is no right to conscientious objection for the doctor. As a result by not participating, a person who commits such an offence will be liable on summary conviction to a term of imprisonment not exceeding 3 months or a fine not exceeding $10,000 or both. So you have a picture of those doctors who are opposing euthanasia, of which there are many, rotating through the prison system.

Based on the statistics for the Netherlands where euthanasia is legal, there would be at least 700 such people euthanised in New Zealand each year. This is clearly not two or three per year. In 2011 in the Netherlands there was increase of 18% to 3695 people who were euthanized; 23% of euthanasia deaths are not reported so 4544 is probably the correct estimate. In the Netherlands in 2012 they planned to have six more mobile euthanasia teams anticipating an additional 1000 deaths this way providing a service for those chronic depression, dementia and loneliness, and for those whose request is declined by their physician.

I visited Nijmegen in the Netherlands for a 1-week course on bioethics including euthanasia several years ago. They showed a documentary with a general practitioner practising euthanasia. My immediate impression was that the doctor was depressed.

S McLeod has written in the Australian New Zealand Journal of Psychiatry that the fatigued, hopeless and despairing doctor confronted by a patient requesting assisted suicide may more subtly encourage the act. Kelly et al, wrote that clinicians burdened with the care of the very sick were frustrated by therapeutic impotency struggling to communicate effectively and seduced by the apparent rationality of the request, may become like their patients, supportive and implicit in quickening death.

Many physicians who have practised euthanasia in the Netherlands said that they would be most reluctant to do it again. In the US state of Oregon, doctors attending persons requesting PAS report being intimidated by patients to assist and have been powerless to influence the decision making process. Oregon doctors reported being personally damaged by the experience. It appears that the personal and professional experience of therapeutically killing is discouraging doctors from accepting these patients on to their books.

Kelly et al draws attention to the complexity of physician response to the care of the terminally ill, reflecting at times their sense of hopelessness and demoralisation. Physicians like all other human beings cannot entirely escape their own prejudices and bias about what constitutes quality of life and a good death and where and whether suffering has meaning.

The goal of medicine is never to give up caring. As a doctor you can harm by a look or by phrase because of the vulnerability of a person who is ill. Such people are extraordinarily vulnerable calling for extraordinary compassionate care. We need skills and knowledge to know how to provide that exquisite competent care.

I have heard Glenn Colquhoun (New Zealand GP and poet) say that medicine is a spiritual profession and that in the patient/doctor relationship the spirit of the patient is exposed. In medicine—a science of the purely subjective—we encounter the ache of being human.

Patelehio writes, “A man who had Alzheimer’s disease and was dying had struggled for so long. He had endured memory loss for many years. All the while his daughter had taken very good care of him. One day towards the end of his life she asked him “do you know who I am?” and he replied “No I don’t know who you are but I love you.”

The legalisation of euthanasia in New Zealand will hurt the profession of medicine irrevocably. The soul of medicine is on trial. Euthanasia will expose further the vulnerable in New Zealand society. Euthanasia will not solve the aching loneliness of our broken society.

Friday, November 23, 2012

The disability rights movement in Washington State has released a document entitled: Too little too late: A call to end tolerance of abuse and neglect.Disability Rights Washington are challenging the Washington state government to reform their abuse response system. Andrea Kadlec, the Director of Community Relations for Disability Rights Washington stated:

The state’s abuse response system is largely unresponsive to reports of individuals with intellectual disabilities in supported living, who are subject to physical harm, psychological trauma, sexual assault and even death, according to a new report issued by Disability Rights Washington and Columbia Legal Services.

These two organizations conducted an in-depth investigation and contracted with two nationally-recognized abuse response system experts who uncovered a Washington state-run system ineffective at keeping people safe. In 85% of serious allegations of abuse and neglect against Supported Living employees, including physical harm, sexual assault and death, there was no evidence, 9 to 12 months later, that an investigation into the specific allegations against the employee had been started. The report also shows how Supported Living providers, certified to serve individuals with intellectual disabilities, operate with very little oversight.

The report outlines five recommendations for the state which include mandating prompt investigations for abuse and neglect, and allocating sufficient staff to complete investigations.

“It is important that Washingtonians reject the state’s flawed abuse response system. We cannot continue tolerating abuse and neglect that is robbing people with intellectual disabilities of their safety and dignity. We must do what we can to respond quickly and effectively to reports of abuse and neglect so that if it is happening, it gets stopped immediately. The current system’s failure to do this is putting too many valuable lives at risk.”

Disability Rights Washington and Columbia Legal Services conducted an in-depth investigation and contracted with two nationally-recognized abuse response system experts who uncovered a Washington state-run system ineffective at keeping people safe. The report outlines five recommendations for the state which include mandating prompt investigations for abuse and neglect, and allocating sufficient staff to complete investigations.

The Euthanasia Prevention Coalition encourages Disability Rights Washington in their demand to protect people with disabilities from abuse and neglect.

EPC wonders if the societal tolerance of abuse and neglect of people with disabilities may also affect the availability of end-of-life care for people with disabilities and we wonder whether people with disabilities have been encouraged to seek assisted suicide, which is legal in Washington State?

There have been several reports in the past few years about people who are being prepared for organ donation, who wake up or shows "signs of life." These stories create a distrust in society concerning the practice of organ donation and it leads to fewer people willing to be organ donors.

A teenage girl who had been stuck in a coma after a catastrophic car crash miraculously woke up just as doctors were about to declare her brain dead and harvest her organs.

Carina Melchior

Doctors had assessed Carina Melchior's chances of recovery as being very low and asked her family whether they would consider organ donation. Her parents agreed and the 19-year-old was taken off of her respirator.

However, after a few days when doctors were preparing her for organ donation, to the astonishment of the staff at the Aarhus University Hospital, in Denmark, Carina suddenly opened her eyes and started moving her legs.

The teenager is now recovering at a rehabilitation center and is now able to walk, talk and even ride her horse Mathilde.

However, her family is now suing the hospital for damages, claiming that doctors took her life support too soon because they were desperate to harvest her body parts.

"Those bandits in white coats gave up too quickly because they wanted an organ donor," Carina's father Kim told the Danish newspaper Ekstra Bladet.

The family's lawyer Nils Fjeldberg said that Carina keeps asking if her doctors were trying to kill her.

"Of course this is a great trauma, both for her and her parents who were convinced that there was nothing else that could be done and agreed to donate her organs," he told the newspaper.
Carina, now 20, had crashed her car in October 2011. She was admitted to the hospital and stayed there for three days before doctors said that her brain activity was fading and consulted her family about stopping treatment. The parents then agreed to donate her organs.

Organ donation can only take place after brain death, the condition in which the irreversible end of all brain activity has set in.

However, in Carina's case, the hospital has acknowledged that they made a serious mistake in her diagnosis.

"We are overjoyed that the young woman survived and that she is moving on after the accident," Claus Thomsen, the hospital's chief medical officer, wrote in a press release, according to The Copenhagen Post. "But we made a mistake underway and made the family believe that their daughter and sister would die."

The hospital also acknowledged that medical staff should not have asked the question of organ donation as there were not clear signs that brain death would occur. In the release, the hospital said that they had implemented new guidelines to make sure that the conversation about organ donation would only occur if there were no more treatment options available and the patient's brain function had either ceased or was expected to cease in a short period of time.

In a documentary about her life called 'The girl who wouldn't die', the 19-year-old said she is sure that she will recover and hopes to move in her own apartment in the future.

"And I will be working as a graphic designer and be able to ride Mathilde properly," she said.

Thursday, November 22, 2012

The debate concerning assisted suicide in the United States has been effected by a false reading of the Baxter decision in Montana. The assisted suicide lobby insists that assisted suicide is legal in Montana, but a closer reading of the Baxter decision recognizes that the court decision did not overturn the law but created a defense for a physician who is prosecuted. Prosecutions for assisted suicide remain possible in Montana and conviction remains possible in Montana.

Recently during the debate in Massachusetts it was stated over and over again that only two states have legalized assisted suicide and in Massachusetts the voters recently rejected (ballot Question 2) assisted suicide.

The following letter was written byDavid W Hafer, DDS, MS and published Ravalli Republic newspaper under the title: Assisted suicide in Montana.

Assisted suicide in Montana

A recent AP article which appeared last Friday in most major newspapers in our state incorrectly stated that Montana is the third state to allow assisted suicide, along with Washington and Oregon.

Attorneys Greg Jackson and Matt Bowman did an extensive analysis of the case and concluded it “did not legalize assisted suicide and it continues to carry both criminal and civil liability for any doctor, institution, or lay person involved.” The Montana Lawyer, the official publication of the Montana State Bar concluded the issue is open to argument, confirming that the legislature needs to clarify the issue this coming session.

As a retired doctor and Montana State Representative for CMDA I your readership needs to know that there are problems inherent in passing a law that would allow a physician to kill their patient. People need to understand that we are talking about a physician writing a prescription for the express purpose of one taking their own life. The very oath that physicians take in stepping into this profession states that they “shall do no harm.” Their purpose is to cure, to heal, to provide comfort and care at the end of life, but not to aid in facilitating the end of that life through active means. Physicians are fallible human beings and often are wrong in their prognosis concerning how long a patient will survive their illness. Often, it is depression that prompts one to think that life if not worth living or perhaps the feeling that because of their illness they are a burden to their family. The whole matter is a recipe for elder abuse.

This is a topic that requires much more discussion and education concerning what it really entails and what is at stake. The Montana Medical Association has drafted its position statement, stating that Boards (i.e. Montana Medical Examiners Board) should not be making position statements without clear statutory authority.

I appreciate the opportunity to set the record straight and hope that you continue to report on this vital topic.

Wednesday, November 21, 2012

The following article was written by Peter Saunders and published on his blog on November 13, 2012 under the title: BBC Panorama findings will heighten calls for review of Tony Bland judgement.For those who have not followed the British case history related to euthanasia, assisted suicide and end-of-life care decision making, the Bland case is the precedent case referred to by all 'common law' court systems concerning the withdrawal of life-sustaining medical treatment. The Bland case is also the precedent case that is being referred to in the Rasouli case in Canada that will be heard by the Supreme Court of Canada on December 10, 2012.The Rasouli case will determine whether doctors in Canada can unilaterally withdraw Life-sustaining Treatment, including fluids and food, without consent, if the doctor deems that the Life-Sustaining Treatment or care is futile.BBC Panorama findings will heighten calls for review of Tony Bland judgement.By Dr. Peter Saunders - November 13, 2012

Fergus Walsh

Tuesday night’s BBC Panorama told the story of a Canadian man who was believed to have been in a vegetative state for more than a decade, being able to tell scientists that he was not in any pain.

According to BBC health correspondent Fergus Walsh, it's the first time an uncommunicative, severely brain-injured patient has been able to give answers clinically relevant to their care. He writes:

‘Scott Routley, 39, was asked questions while having his brain activity scanned in an fMRI machine. His doctor says the discovery means medical textbooks will need rewriting.

Vegetative patients emerge from a coma into a condition where they have periods awake, with their eyes open, but have no perception of themselves or the outside world.

None of his physical assessments since then have shown any sign of awareness, or ability to communicate but the British neuroscientist Prof Adrian Owen - who led the team at the Brain and Mind Institute, University of Western Ontario - said Mr Routley was clearly not vegetative.

"Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is."

Prof Owen said it was a groundbreaking moment.’

In a second article on the BBC website Walsh raises questions about the current law which allows vegetative patients to have food and fluids withdrawn after a court order:

The case is important because in the past two decades, more than 40 vegetative patients have been allowed to die after High Court judges approved the withdrawal of feeding tubes.

This followed a landmark case involving the young Hillsborough victim Tony Bland, who was crushed in the stadium disaster in 1989, suffering terrible brain damage which left him in a vegetative state.

Before any judge decides to sanction the withdrawal of treatment, a thorough behavioural assessment is ordered. But they do not ask for brain scans of the type used by neuroscientists in Cambridge and Ontario to search for hidden awareness.

It is possible that may eventually change.

Much will depend on the view of the working party of the Royal College of Physicians which has been reviewing the College's 2003 guidelines on low awareness states.

People with so-called persistent vegetative state (PVS) may live for ten, twenty or thirty years – in fact the record survival is more than forty.

But since the Tony Bland judgement (picture) in 1992, in which the Law Lords ruled that a young man’s nasogastric feeding tube could be removed with the intention of ending his life, it has been possible in Britain to apply to the courts to withdraw hydration and nutrition from people who are severely brain-damaged but not dying.

But this is possible only for those in PVS and does not apply to other less serious brain damage.

There are estimated to be between 1,000 and 5,000 patients with PVS in Britain today, but so far only 43 have died after court rulings allowing feeding tubes to be removed.

At the time of the Bland case Christian Medical Fellowship expressed serious misgivings about that judgment which we felt crossed a legal rubicon. Three of the reasons for our concern feature in the above account; three concepts embodied in the terms ‘in her best interests’ and ‘further treatment would be futile’.

These terms embrace three important legal precedents established by Bland.

The first precedent is that nutrition and hydration constitute treatment. Our argument was that they constitute rather basic human needs that all of us share. Treatments are aimed at reducing or reversing the effects of an illness. But hydration and nutrition, like air, are simply essential requirements for life. Withdrawing all nutrition and hydration from any human being will result in death. But withdrawing a treatment will only result in the deaths of those who rely on that treatment to stay alive.

The second precedent is that having one’s life actively ended, when one is not actually dying, can be in a person’s best interests. But that is a philosophical position based on a particular world view. We can only make a judgment that death is in a person’s best interests by starting with a set of presuppositions about the nature of life, suffering, morality and death that lead to that conclusion. Our argument was that we have no right to decide what another person’s best interests are. Or alternatively that if we are in any doubt, then the benefit of the doubt should be in the direction of preserving life. Deciding for another person that it is in their best interests to have their life ended is a very dangerous precedent indeed, especially if that person is unable to express an opinion on the matter.

The third precedent is that providing basic care to a person with PVS would be futile. But nutrition and hydration has a real and measurable effect in that it stops a patient dying from dehydration and/or starvation. So how is it futile? It can only be so if a patient’s continued existence itself is judged to be futile. Our argument was that whilst doctors are justified in deciding whether or not a treatment was futile – in that it had no measurable effect or imposed burdens disproportionate to any benefit – they have no right to make judgments about whether a patient’s life is futile.

The assumptions that nutrition and hydration constitute treatment rather than care, that being starved and dehydrated to death can be in a person’s best interests and that the lives of some people are futile are all false assumptions. They should never have been given legal force. But sadly they have.

Having said that it is important to stress that in 20 years since Bland, some thousands of PVS patients have died of natural causes. So the 43 cases that have been taken to court have been a very small minority. In other words, almost always, the intuitions of family and professional carers are that there is a person there with a worthwhile life, even more reason to toughen up the law.

The Bland judgment was seriously flawed and this new data about PVS patients having awareness will heighten calls for its review. Bland and the 43 others who have died after him should not have died in this way. Just how many of them were aware we will now never know. But regardless they should have been given basic care, including nutrition and hydration, until they died naturally.